Chu Michael W, Lieser John D, Sinacori John T
Department of Otolaryngology-Head & Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia 23507, USA.
Arch Otolaryngol Head Neck Surg. 2010 May;136(5):447-52. doi: 10.1001/archoto.2010.59.
To review the experience and outcomes of a novel use of botulinum toxin type A (BtxA) in the treatment of chronic cough.
Retrospective case series.
Academic referral center.
A total of 438 patients were diagnosed as having laryngeal spasm and chronic cough, and 6 were documented as having chronic cough treated with BtxA injections. Two patients were excluded from the study because of a history of tracheostomy or concurrent laryngeal and voice dysfunction.
Electromyography-guided BtxA injections of the thyroarytenoid muscles.
Patient demographics (age and sex), voice-related quality-of-life scores, postprocedure complications, number of BtxA units used, number and length of treatments, and voice outcomes are reviewed.
Three of the 4 patients (75%) were women, and the mean patient age was 55.6 years (range, 38-64 years). All patients had significant relief of cough after BtxA injection, with complete resolution after a median of 7 injections (range, 4-16), using a mean dose of 4.0 U (range, 1.0-10.0 U) per treatment session for a mean duration of 25.7 months (range, 7.2-42.9 months).
To our knowledge, this is the first reported series in the literature of the use of BtxA in the treatment of chronic cough in adults. In this small case series, we report a neuropathic model for chronic cough caused by neuroplastic changes and laryngeal hyperactivity as an explanation for the effectiveness of BtxA treatment. Further research and long-term follow-up are warranted, but BtxA is effective in directly decreasing laryngeal hypertonicity and possibly reducing neurogenic inflammation and neuropeptide-mediated cough. Botulinum toxin type A can be considered for the treatment of chronic cough refractory to other medical therapies.
回顾新型A型肉毒杆菌毒素（BtxA）用于治疗慢性咳嗽的经验及疗效。
回顾性病例系列研究。
学术转诊中心。
共有438例患者被诊断为喉痉挛和慢性咳嗽，其中6例有使用BtxA注射治疗慢性咳嗽的记录。2例患者因有气管切开术病史或并发喉及嗓音功能障碍而被排除在研究之外。
在肌电图引导下对甲杓肌注射BtxA。
回顾患者人口统计学资料（年龄和性别）、嗓音相关生活质量评分、术后并发症、所用BtxA单位数量、治疗次数和时长以及嗓音结局。
4例患者中有3例（75%）为女性，患者平均年龄为55.6岁（范围38 - 64岁）。所有患者在注射BtxA后咳嗽均有显著缓解，中位注射7次（范围4 - 16次）后完全缓解，每次治疗平均剂量为4.0 U（范围1.0 - 10.0 U），平均持续时间为25.7个月（范围7.2 - 42.9个月）。
据我们所知，这是文献中首次报道的关于BtxA用于治疗成人慢性咳嗽的系列研究。在这个小病例系列中，我们报告了一种由神经可塑性变化和喉功能亢进引起的慢性咳嗽的神经病变模型，以此解释BtxA治疗的有效性。需要进一步研究和长期随访，但BtxA能有效直接降低喉肌张力过高，并可能减轻神经源性炎症和神经肽介导的咳嗽。对于其他药物治疗无效的慢性咳嗽，可考虑使用A型肉毒杆菌毒素进行治疗。
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